Safe Meds & Error Reduction

2020 National Patient Safety Goals for the Hospital

1. improve accuracy of patient identification

2. improve the effectiveness of communication among caregivers

3. improve the safety of using medications

Improve accuracy of patient identification goal

Use at least two patient identifiers when providing care, treatment and services.

Improve the effectiveness of communication among caregivers goal

Report critical results of tests and diagnostic procedures in a timely basis.

Improve the safety of using medications.

• Label all medications, medication containers and other solutions on and off the sterile field in perioperative and other procedural settings.

• Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.

• Maintain and communicate accurate patient medication administration.

Each year there are ??? emergency department visits and hospitalization due to adverse drug effects

1 million

Approximately ??? of American adults take at least one medication and nearly ?? take five or more.

Approximately 82% of American adults take at least one medication and nearly 29% take five or more.

causes of med errors

• Transcription

• Prescribing

• Documentation

• Not adhering to the medication rights

• Trailing zeros and not placing a zero in front of the decimal

• Confusing names (similar names)

• Inappropriate use of abbreviations

• Distractions

distractions w med errors

• Poor lighting

• Heat

• Noise

• Interruptions

• Wrong medication- expired/discontinued or contaminated

provider responsibilities

• Obtaining clients’ medical  history and performing a physical examination

• Diagnosing

• Prescribing medications

• Monitoring the response to therapy

• Modifying medication prescriptions as necessary

nursing responsibilities

• Having knowledge of federal, state (nurse practice act), and local laws, and facilities’ policies that govern the prescribing , dispensing, and administration of medications

• Preparing and administering medications, and evaluating clients’ responses to medications

• Developing and maintaining an up-to-date knowledge base of medications they administer

• Maintaining knowledge of acceptable practice and skills competency

• Determining  the accuracy of medication prescriptions

• Reporting all medication errors

• Safeguarding and storing medications

Developing and maintaining an up-to-date knowledge base of medications they administer, including uses:

• Mechanisms of action

• Routes of administrations

• Safe dosage range

• Adverse effects

• Precautions

• Contraindications

• Interactions

principles of med administration

• No medication can be administered without being prescribed by a licensed practitioner.

• Safe  practice dictates that a nurse follows only a written, typed or order entry order.

• Under certain circumstances, such as an Emergency, will a verbal order to a Registered Nurse or Pharmacist be permitted.

• *******Student Nurses are NOT permitted to accept verbal orders.******

• ******There are legal implications for verbal orders. Please follow the policy of the institutions.

Medication Reconciliation:

A process specifying and maintaining an accurate list of medications.

3 checks and rights of medication administration

1. first check

2. second check

3. third check

1st check

1. When retrieving the medication from the storage area (e.g., medication cart, automated dispensing system, or drug cabinet).

2nd check

When preparing the medication, before pouring, mixing, or drawing it up.

third check

 Just before administering the medication to the patient, at the bedside or point of care.

11 rights of medication administration

1. right patient

2. right medication

3. right dose

4. right route

5. right time

6. right reason

7. right assessment

8. right documentation

9. right response

10. right to education

11. right to refuse

right patient

• Ensure that the patient’s full name is used.

• Ask the patient to state their full name and date of birth.

• Compare MAR to identification bracelet and patient’s stated name and birth date.

• Verify allergies each time. Ask their specific reaction.

• Be aware the prescriber could have entered an order in the wrong patient’s medical record.

right medication

• Perform triple checks of all the rights and the medication label.

• Know the brand versus generic names.

• Be aware of names that sound similar.

• Be familiar with the medication.

• Never administer medications prepared by another person.

• Neer administer medication that is not labeled or has been tampered with.

right dose

• Check the label for medication concentration.

• Compare does with medication order.

• Triple check all medication calculations

• Verify that dosage is within appropriate dose range- safe for the patient and therapeutic range for medication

right route

• Verify medication route with medication order before administering.

• Medication may only be administered route specified.

• Identify and use the appropriate medication administration tools needed.

  • Example:

    • Length of the needle

    • Appropriate syringe

    • Oral syringe

    • Etc.

right time

• Verify schedule of medication with the order.

• Date:

  • Check for stop date. Is it scheduled for a certain number of doses or days?

• Time:

  • Maybe dependent on institution policy.

  • If possible administer on patient’s plan of care.

  • Administer medication punctually, as ordered. 

    • Facility policies vary but generally  half-hour before or after the indicated hour.

• Specified frequency:

  • Always check last does of medication given to  patient

• Evaluation of patient within 30 minutes or sooner per medication/policy

right reason

• Confirm the rationale for the ordered medication.

• What is the patient’s history?

• Why are they taking this medication?

• Revisit the reasons for long-term medication use.

right assessment

• Properly assess the patient to determine if the medication is safe and appropriate.

• If unsafe or inappropriate, notify provider immediately.

• If medication was NOT administered document and report.

right documentation

• Complete documentation per facility policy immediately after administration.

• Document and report the appropriate provider any related signs and symptoms.

right response

• Monitor the patient.

• Detect and prevent complications.

• Evaluate any health changes.

• Assess lab values and detect changes.

• Document patient’s response to medication.

• Provide patient education

right to education

• Assess patients knowledge level.

• Provide education regarding:

  • Dosing

  • Administration times

  • Medication side effects

  • contraindications

right to refuse

• The legal responsible party for the patient’s care has the right to refuse any medication.

• Inform patient or responsible party fo consequences of refusing.

• Ensure that the patient understand the consequences of refusal.

• Notify the provider that the ordered medication was not given and document.

• Document refusal and that they fully understand the consequences.

med administration

• Do not administer outdated/expired medications.

• Do not administer beyond the stop date.

• Do not administer a medication that has had some chemical change (color, odor or consistency).

• Administer only medications that are labeled correctly and NOT tapered with.

med errors

• Report all medication errors and near misses per facility policy.

• Never hide an error—patient safety comes first.

• Errors can reveal system issues and drive improvements in patient safety.

when not to administer meds

• Ensure the order is completed and signed by the provider.

• Hold medication if the patient has abnormal physical systems.

• Verify all 11 rights are met.

• Do not administer if the patient or their representative refuses.

• If anything is unclear, double-check before proceeding.

infection control in med administration

• Wash hands thoroughly, scrubbing for 15-30 seconds.

• One needle, one syringe, one patient- every time.

• Always use a new sterile needle and syringe for each vial entry.

• Avoid multi-dose vials whenever possible.

safe med administration

• Avoid distraction- stay in the Red Zone

• Follow policy for co-signing medications.

• Never pre-pour medications.

• Document immediately, not later.

• Verify all rights three times.

• Always double-check allergies.

• Never leave medications at the bedside

safe med administration considerations

• Elevate head and ensure the patient swallows.

• Assess for oral motor issues, including difficulty swallowing, aspiration risk, and tonic biting.

• Consider age-related changes and special needs.

• Use proper landmarking for injections.

• Reconcile medications regularly and per facility policy.

• Monitor continuously for safety.

• Watch for delirium signs (confusion, disorientation).

• Chronic illness & infection can affect medication metabolism and absorption.